Provider Demographics
NPI:1467464479
Name:MARTA, PETER T (DO)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:T
Last Name:MARTA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 POST RD STE M7
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07436-1615
Mailing Address - Country:US
Mailing Address - Phone:201-833-2888
Mailing Address - Fax:201-796-7020
Practice Address - Street 1:9 POST RD STE M7
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:NJ
Practice Address - Zip Code:07436-1615
Practice Address - Country:US
Practice Address - Phone:201-833-2888
Practice Address - Fax:201-796-7020
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013718208600000X
NJ25MB08248700208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ118472XD7Medicare PIN